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Value of Blood Cultures in the Management of Children Hospitalized with Community-Acquired Pneumonia

Youssef, Ahmed S; Fanous, Mina; Siddiqui, Faisal J; Estrada, Jorge; Chorny, Valeriy; Braiman, Melvyn; Mayer, Erick F
Background and objectives Current guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia. Methods We conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity. Results A total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1- 31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia. Conclusion The prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.
PMID: 32582483
ISSN: 2168-8184
CID: 4493412

Case 3: Rapidly Expanding Neck Mass Leading to Cardiopulmonary Arrest in a 14-year-old Boy

Lee, Stanley; Aly, Ahmed; Bhakta, Paayal; Parameswaran, Karthikeyan; Chorny, Valeriy; Pinto, Rohit; Zeng, Jianying; Hong, Richard; Braiman, Melvyn
PMID: 31894073
ISSN: 1526-3347
CID: 4251542

Clinical Practice Update: Point-of-Care Ultrasound for the Pediatric Hospitalist

Kinnear, Benjamin; Kelleher, Matthew; Chorny, Valeriy
PMID: 31891559
ISSN: 1553-5606
CID: 4251402

Perception and knowledge of pediatric and emergency medicine residents about evaluation and management of febrile infants younger than sixty days [Meeting Abstract]

Kopstick, Avi; Aly, Ahmed; Lopez, Maria Chitty; Liang, Tian; Chorny, Valeriy; Braiman, Melvyn
ISSN: 0031-4005
CID: 5006652

Case 1: Joint Pain, Weight Loss, Fatigue, and Persistent Pleural Effusions in 17-year-old Boy [Case Report]

Weaver, Diana; Chorny, Valeriy; Tewari, Sayani
PMID: 25934911
ISSN: 1526-3347
CID: 4064682

Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome) in a 14-Year-Old Child

Bami, Sakshi; Vazquez, Yarelis; Chorny, Valeriy; Goldfisher, Rachelle; Amodio, John
Agenesis of the inferior vena cava (IVC) is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT). No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT.
PMID: 25685585
ISSN: 2090-6803
CID: 2064742

Index of suspicion

Vo, Mary; Patel, Aarat M; Chorny, Valeriy; Sood, Jaspreet; Klein, Thomas J; Chhabra, Susan
PMID: 19884285
ISSN: 1526-3347
CID: 4064672